Department of Medicine I, Division of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, Germany
Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
Eur J Endocrinol. 2018 Oct 1;179(4):261-267. doi: 10.1530/EJE-18-0328.
Adrenal vein sampling (AVS) represents the current diagnostic standard for subtype differentiation in primary aldosteronism (PA). However, AVS has its drawbacks. It is invasive, expensive, requires an experienced interventional radiologist and comes with radiation exposure. However, exact radiation exposure of patients undergoing AVS has never been examined.
We retrospectively analyzed radiation exposure of 656 AVS performed between 1999 and 2017 at four university hospitals. The primary outcomes were dose area product (DAP) and fluoroscopy time (FT). Consecutively the effective dose (ED) was approximately calculated.
Median DAP was found to be 32.5 Gycm2 (0.3–3181) and FT 18 min (0.3–184). The calculated ED was 6.4 mSv (0.1–636). Remarkably, values between participating centers highly varied: Median DAP ranged from 16 to 147 Gycm2, FT from 16 to 27 min, and ED from 3.2 to 29 mSv. As main reason for this variation, differences regarding AVS protocols between centers could be identified, such as number of sampling locations, frames per second and the use of digital subtraction angiographies.
This first systematic assessment of radiation exposure in AVS not only shows fairly high values for patients, but also states notable differences among the centers. Thus, we not only recommend taking into account the risk of radiation exposure, when referring patients to undergo AVS, but also to establish improved standard operating procedures to prevent unnecessary radiation exposure.
肾上腺静脉采样（AVS）是原发性醛固酮增多症（PA）亚型分化的当前诊断标准。然而，AVS 也有其缺点。它是侵入性的，昂贵的，需要有经验的介入放射科医生，并且存在辐射暴露的风险。然而，接受 AVS 的患者的确切辐射暴露从未被检查过。
我们回顾性分析了 1999 年至 2017 年在四所大学医院进行的 656 例 AVS 的辐射暴露情况。主要结果是剂量面积乘积（DAP）和透视时间（FT）。随后，大约计算了有效剂量（ED）。
中位数 DAP 为 32.5Gycm2（0.3-3181），FT 为 18 分钟（0.3-184）。计算得出的 ED 为 6.4mSv（0.1-636）。值得注意的是，参与中心之间的值差异很大：中位数 DAP 范围为 16 至 147Gycm2，FT 范围为 16 至 27 分钟，ED 范围为 3.2 至 29mSv。造成这种差异的主要原因是中心之间的 AVS 方案存在差异，例如采样位置的数量、每秒帧数和数字减影血管造影的使用。
这是对 AVS 辐射暴露的首次系统评估，不仅显示了患者的辐射值相当高，而且还表明了中心之间的明显差异。因此，我们不仅建议在向患者转诊进行 AVS 时考虑到辐射暴露的风险，而且还建议建立改进的标准操作程序以防止不必要的辐射暴露。
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